Linda Thorvaldson1, Mats Remberger2,3, Jacek Winiarski1,4, Brigitta Omazic2,5, Björn Fischler1,6, Mikael Sundin1,4. 1. Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. 2. Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. 3. Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden. 4. Hematology, Immunology and SCT Section, Astrid Lindgren Children's Hospital, Stockholm, Sweden. 5. Department of Clinical Immunology and Transfusion Medicine, Karolinska University Laboratory, Karolinska University Hospital Huddinge, Stockholm, Sweden. 6. Gastroenterology, Hepatology and Nutrition Section, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
Abstract
UNLABELLED: Hepatic dysfunction is common after allogeneic hematopoietic stem cell transplantation (HSCT). The aim of this retrospective study was to determine the risk factors, frequency, and outcome of hepatic complications post-HSCT in children. Two hundred and thirty-seven cases of allogeneic HSCT in children were included. Data on biochemical liver function at start of HSCT, at +1, +3, +6, and +9 months, and at each subsequent yearly follow-up were extracted. Patients were stratified into groups with hepatocellular (none and mild, and moderate to severe) and hepatobiliary (none and present) dysfunction. Statistical analysis included variables such as diagnosis, age, conditioning regimen, and HLA type. RESULTS: One hundred and fifty-six (66%) patients displayed hepatocellular dysfunction post-HSCT. In most cases transient, but 32% had a persistent abnormality three yr post-HSCT. Risk factors were chronic GVHD (OR 4.20, p = 0.003) and donor HLA-A*01 (OR 2.97, p = 0.02). HLA-DQB1*03 decreased the risk (OR 0.35, p = 0.02). Hepatobiliary dysfunction was less frequent (12%) but carried a poor prognosis. aGVHD grade II-IV (OR 2.7, p = 0.02) and long-term TPN (OR 3.25, p = 0.01) increased the risk. CONCLUSION: GVHD is an important risk factor for liver dysfunction post-HSCT. Specific HLA types may also contribute as a risk factor, while others seem to have a protective effect.
UNLABELLED: Hepatic dysfunction is common after allogeneic hematopoietic stem cell transplantation (HSCT). The aim of this retrospective study was to determine the risk factors, frequency, and outcome of hepatic complications post-HSCT in children. Two hundred and thirty-seven cases of allogeneic HSCT in children were included. Data on biochemical liver function at start of HSCT, at +1, +3, +6, and +9 months, and at each subsequent yearly follow-up were extracted. Patients were stratified into groups with hepatocellular (none and mild, and moderate to severe) and hepatobiliary (none and present) dysfunction. Statistical analysis included variables such as diagnosis, age, conditioning regimen, and HLA type. RESULTS: One hundred and fifty-six (66%) patients displayed hepatocellular dysfunction post-HSCT. In most cases transient, but 32% had a persistent abnormality three yr post-HSCT. Risk factors were chronic GVHD (OR 4.20, p = 0.003) and donorHLA-A*01 (OR 2.97, p = 0.02). HLA-DQB1*03 decreased the risk (OR 0.35, p = 0.02). Hepatobiliary dysfunction was less frequent (12%) but carried a poor prognosis. aGVHD grade II-IV (OR 2.7, p = 0.02) and long-term TPN (OR 3.25, p = 0.01) increased the risk. CONCLUSION:GVHD is an important risk factor for liver dysfunction post-HSCT. Specific HLA types may also contribute as a risk factor, while others seem to have a protective effect.
Authors: J Flank; J Sparavalo; H Vol; L Hagen; R Stuhler; D Chong; S Courtney; J J Doyle; A Gassas; T Schechter; L L Dupuis Journal: Bone Marrow Transplant Date: 2017-06-05 Impact factor: 5.483